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At the end of the lecture, the students should be able to:  Discuss the theoretical basis of the sensorimotor approaches  Identify the traditional sensorimotor.

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Presentation on theme: "At the end of the lecture, the students should be able to:  Discuss the theoretical basis of the sensorimotor approaches  Identify the traditional sensorimotor."— Presentation transcript:

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2 At the end of the lecture, the students should be able to:  Discuss the theoretical basis of the sensorimotor approaches  Identify the traditional sensorimotor approaches to therapeutic exercise  Discuss the reconstruction of the sensorimotor approaches  Differentiate and discuss the sensorimotor approaches to therapeutic exercise in terms of: › Proponents › Principles › Techniques/procedures › Components

3  Brunnstrom’s movement therapy  Neurodevelopmental approach  Rood approach  Proprioceptive neuromuscular facilitation

4 Reflex and Hierarchical Theory  The basic unit of motor control are reflexes › Reflexes  purposeful movement › Damage to the CNS results to re-emergence of and inability to control the reflexes  Motor control is hierarchically arranged › CNS structures involved with movement can be grouped into HIGHER, MIDDLE, and LOWER levels › Higher centers regulate and control the middle and lower centers › Damage to the CNS results to disruption of the normal coordinated function of these levels

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6  Motor patterns are developed from fundamental patterns/reflexes which are refined and controlled as an individual matures  Sensory stimulation is applied to muscles and joints  normalize tone  produce desired movement  Sensorimotor control is developmental  Movement should be purposeful  Repetition of sensorimotor responses is necessary

7  Tonic neck and labyrinthine reflexes can assist or retard the effects of sensorimotor stimulation  Stimulation of specific receptors to produce response Rules on sensory input › A fast, brief stimulus produces a large synchronous movement › A fast, repetitive stimulus produces a maintained response › Slow, rhythmical, repetitive sensory input deactivates the body

8  Muscles have different duties › Heavy work muscles: stabilizers  Maintenance of posture › Light work muscles: mobilizers  Skilled movement, repetitive or rhythmical patterns of distal musculature  Heavy work muscles should be integrated before light work muscles

9  Reciprocal inhibition › Aka innervation, mobility › Phasic or quick type of movement › Contraction of the agonist while antagonist relaxes › Serves a protective function  Cocontraction › Aka coinnervation, stability › Tonic or static type of movement › Simultaneous contraction of the agonist and antagonist › Foundation for postural control

10  Heavy work › Aka mobility superimposed on stability › Proximal muscles contract and move while distal segments are fixed  Skill › Aka mobility and stability › Proximal segments are stabilized while distal segments move

11  Supine withdrawal (supine flexion)  Rollover to sidelying  Pivot prone (prone extension)  Neck cocontraction  Prone on elbows  Quadruped  Standing  Walking

12 Facilitatory Techniques Cutaneous Facilitation 1. Light moving touch 2. Fast brushing Thermal Facilitation 1. A-icing 2. C-icing 3. Autonomic icing Proprioceptive Facilitation 1. Heavy joint compression 2. Quick stretch 3. Intrinsic stretch 4. Secondary ending stretch 5. Stretch pressure 6. Resistance 7. Tapping 8. Vestibular stimulation 9. Inversion 10. Therapeutic vibration 11. Osteo- pressure

13 Inhibitory Techniques 1. Neutral warmth 2. Gentle shaking or rocking 3. Slow stroking 4. Slow rolling 5. Tendinous pressure 6. Light joint compression 7. Maintained stretch 8. Rocking in developmental poistions

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15  Brain knows nothing of individual muscle action, rather, total movement patterns  Extremity patterns of movement are rotational and diagonal in nature  Normal motor development proceeds in a cephalo-caudal and proximo-distal direction  Early motor behavior is dominated by reflex activity; Mature motor behavior is supported by postural reflexes

16  All human beings have untapped movement potential  Improvement in motor ability is dependent upon motor learning  Frequency of stimulation and repetition of activity promotes retention of motor learning and develops strength and endurance  Activities are goal-directed with techniques of facilitation, mainly proprioceptive, are utilized to hasten learning

17  Mass movement patterns observed in most functional activities › Head, neck, trunk  Flexion with rotation to the right or left  Extension with rotation to the right or left › Extremities  Three components  Flexion/extension  Abduction/adduction  External/internal rotation  Reference points  UE: shoulder joint  LE: hip joint

18 UPPER EXTREMITY D1 pattern JOINTFLEXIONEXTENSION Scapula Elevation, Abduction, Rotation Depression, Adduction, Rotation Shoulder Flexion, Adduction External rotation Extension, Abduction Internal rotation Elbow Flexion or Extension Forearm SupinationPronation Wrist and Hand Flexion to the radial side, Finger flexion and adduction, Thumb adduction Extension to the ulnar side, Finger extension and abduction, Thumb in palmar abduction

19 UPPER EXTREMITY D2 pattern JOINTFLEXIONEXTENSION Scapula Elevation, Adduction, Rotation Depression, Abduction, Rotation Shoulder Flexion, Abduction External rotation Extension, Adduction Internal rotation Elbow Flexion or Extension Forearm SupinationPronation Wrist and Hand Extension to the radial side, Finger extension and Abduction, Thumb extension Flexion to the ulnar side, Finger flexion and adduction, Thumb in opposition

20 LOWER EXTREMITY D1 pattern JOINTFLEXIONEXTENSION Hip Flexion Abduction External rotation Extension Adduction Internal rotation Knee Flexion/extension Ankle and Foot Dorsiflexion Inversion Plantarflexion Eversion Toe ExtensionFlexion

21 LOWER EXTREMITY D2 pattern JOINTFLEXIONEXTENSION Hip Flexion Abduction Internal rotation Extension Adduction External rotation Knee Flexion/extension Ankle and Foot Dorsiflexion Eversion Plantarflexion Inversion Toe ExtensionFlexion

22  Combined upper extremity or lower extremity diagonal patterns › Symmetrical › Asymmetrical › Reciprocal

23  Symmetrical › Paired extremities (either UE of LE) perform the same diagonal pattern and direction › Promotoes trunk flexion and extension

24  Asymmetrical › Paired extremities perform opposite diagonal pattern but same direction › Facilitates trunk rotation

25  Reciprocal › Paired extremities move in opposite diagonal pattern and direction › Promotes head, neck, and trunk stability

26  Combined upper extremity and lower extremity movements › Ipsilateral › Contralateral › Diagonal reciprocal

27  Ipsilateral › Extremities of the same side (UE and LE) move in the same diagonal pattern and direction

28  Contralateral › Aka alternating reciprocal pattern › Extremities of the opposite sides move in the same diagonal pattern and direction

29  Diagonal reciprocal › Contralateral extremities moving in the same diagonal patterns and directions while opposite contralateral extremities move in the opposite diagonal pattern and direction

30  Manual contacts  Communication/commands  Stretch  Traction  Approximation  Maximal resistance  Timing

31  Placement of the therapist’s hand on the patient  Used to provide pressure and tactile stimulation to muscles › Pressure should be applied opposite to the direction of the desired motion  Guide direction of movement  Utilized by the patient as in “self-touching” during chopping and lifting movements

32  effective use of volume and tone of voice can be facilitatory or inhibitory (use in moderation to not avoid adaptation)  preparatory commands need to be clear and concise  action commands should be accurate, short, and timed  provide visual cues, demonstration of movement  tailor your motivation strategies; know your patient (developmental and cognitive level)

33  part to be moved must be placed in the extreme lengthened range of the pattern; all parts being considered; tension should be felt in all muscle components  apply stretch reflex manually by quickly taking the stretched part beyond point of tension then instructing the patient to perform the desired motion

34  separating joint surfaces stimulate the proprioceptive centers  promote movement  used during pulling motions

35  compressing joint surfaces stimulate the proprioceptive centers  promote stability or maintenance of posture as well as postural reflexes  ensure proper alignment of the joint structures

36  maximum amount of resistance that can be applied without breaking the patient’s hold (Voss, et al., 1985)  principle of irradiation/overflow › weaker muscles are reinforced or strengthened by resisted contraction of the stronger muscle components  increases strength

37  Refers to the sequence of muscle contraction that occurs during activity  Normal timing (PNF) › Distal segments move first followed by proximal segemts › Rotation occurs throughout the pattern  Timing for emphasis › Superimposing maximal resistance upon patterns of facilitation in order that overflow or irradiation occurs

38  Reversal of antagonists › Dynamic reversals › Stabilizing reversals › Rhythmic stabilization  Directed to the agonists › Repeated contractions › Rhythmic initiation › Combination of isotonics › Resisted progression  Relaxation Techniques › Contract relax › Hold-relax › Replication › Rhythmic rotation

39  Dynamic Reversals › Aka Slow reversals › Isotonic contractions of agonist  isotonic contraction of antagonist › Contraction of the stronger pattern then progressed to weaker pattern › Indications  impaired strength and coordination  limitation of motion  fatigue

40  Stabilizing Reversals › Alternating isotonic contractions of the agonists then antagonists › Very limited motion (ROM) allowed › Indications  Impaired strength  Impaired stability and balance  Impaired coordination

41  Rhythmic Stabilization › Alternating isometric contractions of the agonist then antagonist › No motion is allowed › Indications  Impaired strength  Impaired coordination  Limitation of motion  Impaired stabilization control and balance

42  Repeated contractions › Repeated isotonic contractions from the lengthened range (induced by quick stretch and enhanced by resistance) › Performed throughout the range or part of the range at a point of weakness › Indications  Impaired strength  Impaired initiation of movement  Fatigue and LOM

43  Rhythmic Initiation › Aka Rhythm Technique › voluntary relaxation  passive movement  active-assisted movement  repeated isotonic contraction of major muscle components of the pattern (gradually increasing as patient responds)  active motion › Indications  Inability to relax  Hypertonicity  Difficulty initiating movement  Motor planning and motor learning deficits  Deficits in communication

44  Combination of Isotonics › Aka Agonist Reversal › Resisted concentric contraction of agonist muscles moving through the range  stabilizing contraction (holding)  eccentric lengthening contraction (moving slowly back to starting position) › No relaxation between contractions › Indications  Weak postural muscles  Inability to eccentrically control body weight during transitions  Poor dynamic postural control

45  Resisted Progression › Stretch, approximation, and tracking resistance applied manually to facilitate pelvic motion and progression during movement › Indications  Impaired timing and control of lower trunk/pelvic segments during movement  Impaired endurance

46  Contract-Relax › Performed at a point of LOM › Strong, small range isotonic contraction of the antagonist  isometric contraction (hold: 5 to 8 seconds)  voluntary relaxation  passive movement into new range of the agonist pattern › Contract-relax-active contraction : same as contract relax but active movement into the new range › Indication  Limitation of motion

47  Hold-relax › Performed in a position of comfort and below level of pain › Isometric contraction of the antagonist  voluntary relaxation  passive movement into the new range › Hold-relax-active contraction: same as hold-relax but movement into new range is active › Indication  Limitation I PROM with pain

48  Rhythmic Rotation › Slow, repetitive rotation of a limb at a point where LOM is noted › Limb is slowly moved into new range as muscles relax › Repeated whenever tension is felt › Indication  Relaxation of excess tension in muscles (hypertonia) combined with PROM of the range-limiting muscles

49 Adler SA, Beckers D, & Buck M (1993). PNF in practice. Berlin, Springer-Verlag. Levitt S (2004). Treatment of cerebral palsy and motor delay (4 th ed). Singapore, McGraw-Hill Inc. O’Sullivan S & Schmitz T (2007). Physical rehabilitation (5 th ed). Philadelphia, F. A. Davis Company. Pedretti LW & Early MB (Eds) (2006). Occupational therapy: Practice skills for physical dysfunction (6 th ed). St. Louis, Mosby-Year Book, Inc. Tecklin JS (1999). Pediatric physical therapy (3 rd ed). Philadelphia, J.B. Lippincott Company. Voss DE, Ionta MK, & Myers BJ (1985). Proprioceptive Neuromuscular Facilitation: Patterns and techniques (3 rd ed). Philadelphia, Harper & Row Publishers.


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